COVID-19 vaccines safe, do not worsen MS symptoms: Study

Certain COVID-19 vaccines do not appear to worsen the symptoms of multiple sclerosis (MS), and may provide protection for at least six months after a booster dose, according to a study in Spain.

The study specifically examined mRNA vaccines, or those that use a piece of RNA to teach cells how to make a protein — or a piece of a protein — that triggers an immune response against SARS-CoV-2, the virus that causes COVID-19.

Getting vaccinated also appeared to be safe and did not trigger the development of other autoimmune diseases, one of the main concerns often associated with COVID-19 vaccines, researchers noted.

The study, “mRNA COVID-19 Vaccination Does Not Exacerbate Symptoms or Trigger Neural Antibody Responses in Multiple Sclerosis,” was published in the journal Neuroimmunology & Neuroinflammation.

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COVID-19 may be risk factor in MS

Infection with SARS-CoV-2 may set the stage for MS to develop and has been reported to worsen symptoms and speed disability in people with the autoimmune disease.

While COVID-19 vaccines can protect against more severe complications, many MS patients worry that getting vaccinated may trigger a relapse — where new symptoms appear or existing ones worsen — or cause other autoimmune diseases.

However, most studies examining the effect of COVID-19 vaccines in MS patients have been retrospective, meaning they looked back at patient records, and often over a short period of time.

To know more, a team of researchers in Spain set out to study immune cell responses to SARS-CoV-2 in MS patients who received mRNA vaccines, such as those developed by Moderna and Pfizer-BioNTech, as well as changes in disease activity and development of new self-antibodies.

Their study enrolled 390 people with MS, including 22 adolescents, who were being followed at two centers in Barcelona and received their COVID-19 vaccines in 2021. They were followed up for one year after their vaccination.

Most (72.8%) of the patients were women and the majority (88.2%) had relapsing types of MS. Their mean age was 44.5 years, and median disease duration was 131 months, or about 11 years.

The study also included 64 people with other autoimmune diseases, including myasthenia gravis,  neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody-associated disease.

The majority of adult patients (94%) were vaccinated with Moderna’s mRNA-1273 vaccine, and all but one adolescent received Pfizer-BioNTech’s BNT162b2 vaccine.

After vaccination, the immune response usually involves the production of antibodies, which are the major component of so-called humoral immunity. Most patients will also develop specific immune cells, including T-cells, that are primed to target the virus — this is called cellular response.

mRNA COVID-19 vaccination was safe and did not exacerbate the autoimmune disease nor triggered neural autoantibodies or immune-mediated neurologic disorders.

To check how well the patients’ immune systems responded to the COVID-19 vaccines, the researchers measured the levels of anti-SARS-CoV-2 antibodies and T-cells in blood at various time points.

A typical vaccination schedule for mRNA vaccines involves two doses given 3-8 weeks apart. Because protection may wane after the second dose, a third (booster) dose may be offered at least eight weeks after the second dose.

In this study, antibodies were detected in 367 (86%) patients one month after the second dose. A total of 394 patients received a booster dose a median 5.7 months after the second dose. About 6 months after the booster dose, most (92%) still tested positive for the antibodies.

“No differences were found between adults and adolescents with MS,” the researchers wrote. There were also no differences between people with MS and those with other autoimmune diseases.

However, patients treated with anti-CD20 therapies like Ocrevus (ocrelizumab) or with fingolimod (sold as Gilenya and generics) had significantly lower antibody levels than the remaining patients.

A T-cell immune response was detected in 93% patients one month after the second dose, with one in four patients having both humoral and cellular responses. Nearly six months after the booster dose, it was still detected in most (91%) patients, and all negative patients who were on CD20 inhibitors became positive.

While a T-cell immune response was detected at the same time point in 79% of patients on fingolimod, those using this disease-modifying therapy were more likely to mount no cell-mediated immune response.

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COVID-19 vaccination seen not to increase MS relapses or disability levels

Regarding disease activity, there were no signs that COVID-19 vaccination increased relapses or disability levels after one year. In fact, the annualized relapse rate, a measure of the number of relapses occurring within a year, dropped significantly after one year of follow-up — from 0.19 at the study’s start to 0.09 relapses per year.

None of the patients developed neural antibodies after vaccination. Neural antibodies are autoantibodies associated with a range of autoimmune diseases of the brain and spinal cord.

Although 180 (39.6%) patients tested positive for SARS-CoV-2, two of them twice, there were no severe infections. Most of the infections occurred in the period when the Omicron variant became predominant in Spain.

In MS, reactions to COVID-19 vaccines were similar to those reported in people with other autoimmune diseases. After the first dose, the most common side effects were pain at the injection site (86.9%) and fatigue (35.9%).

“The outcome of patients who developed SARS-CoV-2 infection was favorable,” the researchers concluded. “mRNA COVID-19 vaccination was safe and did not exacerbate the autoimmune disease nor triggered neural autoantibodies or immune-mediated neurologic disorders.”